Ketelaar Elise N, Wagner Michael, Lorenzo Adam, Comrie Robert, Restini Carolina, Brannan Grace D, Corvasce Roger, Mohammad Saad
Orthopedic Surgery, Beaumont Health, Farmington Hills, USA.
Orthopedic Surgery, McLaren Macomb Hospital, Mount Clemens, USA.
Cureus. 2024 Feb 24;16(2):e54835. doi: 10.7759/cureus.54835. eCollection 2024 Feb.
Tourniquets have long been used in total knee arthroplasty due to the theoretical improvement of bleeding control, integration of cement-bone interface, visibility, and efficiency of the overall surgery. However, this has become increasingly disputed. Comparative studies in total knee arthroplasty employing chemical prophylaxis, i.e., tranexamic acid, have been conducted. This retrospective cohort study evaluated the effect of tranexamic with or without a tourniquet on mean blood loss, hemoglobin, and length of stay in total knee arthroplasty patients. A total of 153 patients' records met the inclusion criteria, 95 patients (62%) were in the tranexamic acid-only group while 58 patients (38%) were in the tranexamic acid plus tourniquet group. Based on mean blood loss in mL (827.5 without vs. 810.1 with the tourniquet, p=0.805), hemoglobin counts in g/dL (12.6 without vs. 12.5 with the tourniquet, p=0.598), and length of stay in days (1.0 days without vs. 1.1 with the tourniquet, p=0.204), there was no statistical difference between the tranexamic alone vs. tranexamic plus tourniquet groups. There were no statistical differences in the mean BMI between groups (32.3 without vs. 32.4 with tourniquets, p=0.901). The patient population had more women (64.1%) than men (35.9%) (p=0.001), but no significant difference in gender based on tourniquet use (p=0.521). The tourniquet group averaged three years younger than the tranexamic alone group (age mean 68.2 without vs 65.3 with tranexamic, p=0.029). This study found no identifiable difference in the three observed variables, indicating that tourniquet provides limited to no additional benefit in reducing blood loss over tranexamic alone in total knee arthroplasty, while tranexamic alone has no deleterious decrease in mean hemoglobin or increase in length of stay.
由于理论上止血效果更好、骨水泥与骨界面结合更佳、视野更清晰以及整体手术效率更高，止血带长期以来一直用于全膝关节置换术。然而，这一做法越来越受到争议。已经开展了在全膝关节置换术中采用化学预防（即氨甲环酸）的对比研究。这项回顾性队列研究评估了氨甲环酸单独使用或联合止血带对全膝关节置换术患者平均失血量、血红蛋白水平和住院时间的影响。共有153例患者的记录符合纳入标准，95例患者（62%）在仅使用氨甲环酸组，而58例患者（38%）在氨甲环酸加止血带组。基于以毫升为单位的平均失血量（不使用止血带为827.5，使用止血带为810.1，p = 0.805）、以克/分升为单位的血红蛋白计数（不使用止血带为12.6，使用止血带为12.5，p = 0.598）以及以天为单位的住院时间（不使用止血带为1.0天，使用止血带为1.1天，p = 0.204），仅使用氨甲环酸组与氨甲环酸加止血带组之间无统计学差异。两组之间的平均体重指数无统计学差异（不使用止血带为32.3，使用止血带为32.4，p = 0.901）。患者群体中女性（64.1%）多于男性（35.9%）（p = 0.001），但基于是否使用止血带的性别差异无统计学意义（p = 0.521）。止血带组的平均年龄比仅使用氨甲环酸组小3岁（不使用止血带组平均年龄为68.2岁，使用氨甲环酸组为65.3岁，p = 0.029）。本研究发现，在观察到的三个变量中没有可识别的差异，这表明在全膝关节置换术中，与单独使用氨甲环酸相比，止血带在减少失血量方面的额外益处有限或没有额外益处，而单独使用氨甲环酸不会导致平均血红蛋白水平有害下降或住院时间增加。
